Introduction: the global perspective

Respiratory diseases are among the leading causes of death worldwide (table 1). Lung infections (mostly pneumonia and tuberculosis), lung cancer and chronic obstructive pulmonary disease (COPD) together accounted for 9.5 million deaths worldwide during 2008, one-sixth of the global total. The World Health Organization estimates that the same four diseases accounted for one-tenth of the disability-adjusted life-years (DALYs) lost worldwide in 2008 (table 2).

The Global Burden of Disease (GBD) Study recently compared the contribution of major diseases to deaths and disability worldwide for 1990 and 2010. Among the leading causes of death, lower respiratory infections were ranked 3rd in 1990 and 4th in 2010, whereas COPD was ranked 4th in 1990 and 3rd in 2010. Lung cancer rose from 8th- to 5th- commonest cause of death, while tuberculosis fell from 6th to 10th position in the ranking.

The GBD Study also presented rankings for years lived with disability, among which asthma ranked 13th worldwide in 1990 and 14th in 2010, while COPD ranked 6th in 1990 and 5th in 2010. When premature deaths and disability were combined as DALYs lost, lower respiratory infections were ranked the leading cause worldwide in 1990, and the 2nd most important cause of DALYs lost in 2010. Also among the 25 most important causes were COPD (ranked 6th in 1990 and 9th in 2010), tuberculosis (ranked 8th in 1990 and 13th in 2010) and lung cancer (ranked 24th in 1990 and 22nd in 2010).

These figures confirm that lung diseases have remained globally important causes of death and disability during the past two decades.

Deaths attributed to

Worldwide

WHO European Region

Ischaemic heart disease

7.3 million (12.8%)

2.40 million (24.7%)

Cerebrovascular disease

6.2 million (10.8%)

1.40 million (14.0%)

Lower respiratory infections

3.5 million (6.1%)

0.23 million (2.3%)

COPD

3.3 million (5.8%)

0.25 million (2.5%)

Diarrhoeal diseases

2.5 million (4.3%)

0.03 million (0.3%)

HIV/AIDS

1.8 million (3.1%)

0.08 million (0.8%)

Trachea/bronchus/lung cancer

1.4 million (2.4%)

0.38 million (3.9%)

Tuberculosis

1.3 million (2.4%)

0.08 million (0.8%)

Diabetes mellitus

1.3 million (2.2%)

0.17 million (1.7%)

Road traffic accidents

1.2 million (2.1%)

0.12 million (1.2%)

Table 1 – The 10 most common causes of death in 2008. Source: World Health Organization (WHO) World Health Statistics 2011.

DALYs lost to

Worldwide

WHO European Region

Lower respiratory infections

79 million (5.4%)

2.2 million (1.5%)

HIV/AIDS

65 million (4.4%)

2.6 million (1.8%)

Ischaemic heart disease

64 million (4.4%)

16.0 million (11.3%)

Diarrhoeal diseases

56 million (3.8%)

1.1 million (0.7%)

Cerebrovascular disease

48 million (3.3%)

9.3 million (6.4%)

Road traffic accidents

45 million (3.1%)

3.4 million (2.4%)

COPD

33 million (2.3%)

2.9 million (2.0%)

Tuberculosis

29 million (2.0%)

1.7 million (1.2%)

Diabetes mellitus

22 million (1.5%)

2.6 million (1.8%)

Trachea/bronchus/lung cancer

13 million (0.9%)

3.2 million (2.2%)

Table 2 – The 10 most common causes of disability-adjusted life-years (DALYs) lost worldwide in 2008.Source: World Health Organization World Health Statistics 2011.

Where does the information come from?

This White Book includes all countries of the World Health Organization (WHO) European Region, which extends from the Atlantic coast to central Asia. The 28 countries of the European Union (EU28) have been distinguished for some presentational purposes. Within the EU28, 14 countries have reported data for both mortality and hospital admissions for recent years in a form that allows a detailed breakdown by respiratory condition. These 14 countries were selected for illustrative comparisons of disease burden in figures 3, 4, 8 and 9.

There are two main sources of Europe-wide data on hospital admissions: the WHO-Europe Hospital Morbidity Database (HMDB) and data from the European commission statistical agency, Eurostat. This publication uses information from HMDB where available, supplemented with Eurostat data. Data are available from the WHO database on hospital admissions (discharges and deaths), day-cases, and bed-days for 27 European countries. Eurostat supplies discharge data for 30 countries of which nine supplement the HMDB data. These are available for a limited set of conditions on the International Short Hospital Morbidity Tabulation (HMT). The non-HMT respiratory conditions, which comprise a small proportion of the total admissions for lung disease, are shown separately in figure 5, for countries where they are available.